My opinion - In the serious cases these people are already victims and their minds may well be primed by their situation for this sort of thing to take over. Consider as well that many people, even educated, never really learn how to properly sift through this stuff. I would be a bit hesitant to blame the victim, if ignorance is the problem then education is the solution. If denial is the problem..then I'm not sure where to fit victim responsibility into it if at all.

To the moon wrote:

The ending isn't any more important than any of the moments leading to it.

Mostly, I just wish alternative medicine practitioners and suppliers of alt-med products were held responsible for making unreasonable claims. If you claim that spinal manipulation or homeopathic pills will cure someone's cancer, and they don't, you should be liable. If we could only enforce that I think a lot of other problems would dry up. Obviously some people would still refuse medical treatment, but at least it wouldn't be because some woo-peddler lied to them.

I think it would be reasonable, if these guys are banking on saying "Oh, it's only entertainment" as a defense against lawsuits, for them to be required by law to state out loud "This procedure is for entertainment purposes and is not meant to be a substitute for any medical advice or procedure."

Make it unambiguous. People are still going to go "wink wink, nudge nudge, we're only saying this because the government is interfering and makes us say it", but at least make them say it so that somebody who's confronted with "something is growing in my abdomen" keep hearing it and think about whether maybe, just maybe, a doctor should have a look at what's going on.

Yes, it's not going to help everybody. But it is absolutely not unreasonable for us to say that enough is enough, and that these folks don't get to imply that their practices are known to be effective on one side while hedging and saying that their practices are just for entertainment purposes on the other.

Sweet manager, I cannot code—
slender Aphrodite has overcome me
with longing for a girl.

I think it would be reasonable, if these guys are banking on saying "Oh, it's only entertainment" as a defense against lawsuits, for them to be required by law to state out loud "This procedure is for entertainment purposes and is not meant to be a substitute for any medical advice or procedure."

Agreed. I gather typical nurses and doctors would be raked over the coals for prescribing an unproven/unverified treatment without going through extensive explanations and legal paper work to fully establish in the patient's head that "This is a trial study (...)". Should the patient get worse than normally expected on such a trial I imagine they would be required by oath if not law to stop that treatment immediately.

I think the entertainers should also be required to stop seeing a worsening or chronic condition as a dollar sign and to urge those entertainees to get proper treatment.
"I'll still do my best to entertain you if you want but only on the condition that you also go see a doctor."

How much of a factor might American privatized medicine be for the patients seeking this stuff? These services are not exactly cheap but perhaps for the uninsured it's still a hell of a lot less scary than contemplating a medical bill? We still have such things up here and I gather they do in Europe, so that's certainly not the only factor if it is one.

To the moon wrote:

The ending isn't any more important than any of the moments leading to it.

I think it would be reasonable, if these guys are banking on saying "Oh, it's only entertainment" as a defense against lawsuits, for them to be required by law to state out loud "This procedure is for entertainment purposes and is not meant to be a substitute for any medical advice or procedure."

Make it unambiguous. People are still going to go "wink wink, nudge nudge, we're only saying this because the government is interfering and makes us say it", but at least make them say it so that somebody who's confronted with "something is growing in my abdomen" keep hearing it and think about whether maybe, just maybe, a doctor should have a look at what's going on.

Yes, it's not going to help everybody. But it is absolutely not unreasonable for us to say that enough is enough, and that these folks don't get to imply that their practices are known to be effective on one side while hedging and saying that their practices are just for entertainment purposes on the other.

I've spoken to some other cancer patients who have asked me (very enthusiastically), how I feel about various alternative treatments. Burzynski seems a popular one lately. It breaks my heart (and theirs, when I give them my opinion). When you claim you have a 60% success rate at curing cancer, that is not "entertainment." That is making a profit off the desperate hopes of the terminally ill, and there is nothing more evil.

I think we should treat them the same way we treat anyone who takes money for a service they don't intend to deliver: charge them with fraud.

krev82 wrote:

"I'll still do my best to entertain you if you want but only on the condition that you also go see a doctor."

That would be a good start. At some point it's not a matter of legal responsibility but of humanity. They are watching their patients kill themselves (and they are charging for it).

That guy makes me so damn angry. Making false promises to sick people is bad enough, but purposely keeping your treatment in a trial state so you don't have to prove anything, then charging cancer patients a fortune to take part in bullsh*t "clinical trials" is downright evil.

That guy makes me so damn angry. Making false promises to sick people is bad enough, but purposely keeping your treatment in a trial state so you don't have to prove anything, then charging cancer patients a fortune to take part in bullsh*t "clinical trials" is downright evil.

I waffle. I agree with the sentiment that FDA or AMA oversight/regulation serves more to legitimize pseudo medicine. On the flip side we have people suffering, dying, being defrauded of money. Problematic is that snake oil in whatever form is nothing new. It was not so long ago bloodletting was a treatment for infections. Mark Twain wrote a scathing critique of Christian Science faith healers. I doubt this can ever be stamped out.

What is troubling me is when I watch documentaries, tv spots on the stuff.

On the flip side, people turned against Opra when she did an anti-vaccine special.

I think the best we can do is shoot Tim Farley of whatstheharm.net a donation.

One pattern that seems to repeat itself and really gets me aggravated:

Alternative medicine user finally breaks down and sees a real doctor when they realize they're not getting any better, but by then it's too late. Then they blame their further decline on the doctor and the mainstream medicine, chemotherapy, whatever.

Not entirely true. There are acupuncture techniques that have been proven to work with peer reviewed studies. There's even neurochemical investigations going on right now that's trying to find out on a theoretical level exactly why this voodoo stuff works as well as it does when every conventional medical theory we have says that they shouldn't (and no, we won't accept meridians as a good scientific theory).

It's still called alternative medicine, though we now have acupuncture sections in the more well-funded hospitals to administer the proven treatments.

It's not the techniques themselves that are at fault - it's the people who lack critical thinking and accept the veracity of things on other people's say-so.

I'll add that the perfectly understandable outrage of medical practitioners in your locality over the tragedies brought on by snake oil salesmen styling themselves "alternative health experts," is also confusing the issue.

There are too many people who are willing to believe in the lack of efficacy of practices without proof to that effect, when they ought to be concentrating on the questionable practice of selling health treatments without oversight or accountability.

It's not the techniques themselves that are at fault - it's the people who lack critical thinking and accept the veracity of things on other people's say-so.

...There are too many people who are willing to believe in the lack of efficacy of practices without proof to that effect, when they ought to be concentrating on the questionable practice of selling health treatments without oversight or accountability.

This is where I'm at with it. I'm lucky enough to live in a place well-saturated with good, evidence-based practitioners who have good schooling and encourage people to also work with their MD or otherwise licensed, accepted-by-insurance PCP.

But it's also highly regulated here- naturopaths, acupuncturists, chiropractors, "nutritionists", massage therapists, and anyone who offers counseling or "therapy" need to be licensed with the state Department of Health- just like any MD or nurse or paramedic.

My own doc is an MD who had me test a round of (moderately successful) herbal treatment for a condition before moving to conventional steroids, and was delighted to hear that I had wild success with lymphatic massage and now need less of said steroids. But he's the kind of guy who refers out to acupuncturists for pain treatment, prescribes meditation in addition to ADD meds, and is way involved with the NIH NCCAM thing.

I think if I came from an unregulated part of the country where all I saw around me were the hacks, I'd be a lot more resistant to the whole idea... I've had great, professional, respectable chiropractors here and in Michigan, but the only types I ever met in Florida were the sleazy, supplement-pimping, snake-oil guys. If that was all I knew of chiros (or acupuncturists or whatever) I'd probably hate the entire thing. Not to say it's perfect here- we have our share of anti-vax assholes and crystal healers- but at least here your medical intuitive is going to tell you to go to a real doc if you're obviously ill.

Many people are douchebags and scam artists, but I'm not going to discard the entire concept any more than I'm going to write off going to any MD because there are some old fart doctors out there who haven't read a medical journal in 20 years and continue to push outdated treatments that are now shown to be ineffective or even harmful.

Not entirely true. There are acupuncture techniques that have been proven to work with peer reviewed studies. There's even neurochemical investigations going on right now that's trying to find out on a theoretical level exactly why this voodoo stuff works as well as it does when every conventional medical theory we have says that they shouldn't (and no, we won't accept meridians as a good scientific theory).

One such study came out a few years ago, but it didn't actually say much about the efficacy of acupuncture... The beneficial effects were the same whether the practitioner used "proven acupuncture techniques" or just jabbed someone randomly with the needles (or even just prodded them with toothpicks), suggesting that the beneficial effects were due either to the placebo effect or just the bodily response to being violated by needles, rather than the pseudoscience behind the acupuncture process.

The first link is an editorial, not a study, and the "study" it's referencing is a review of reviews - third hand meta-analysis at best.

The second link is a test of a specific technique for a specific complaint. It may or may not be more effective than placebo, but the fact that they failed to account for placebo effect is itself a sign of questionable study design. Suggesting inefficacy due to placebo effect without actually including testing it out suggests a biased perspective, since all reputable controlled studies ought to have placebo controls.

It is, of course, an anecdotal account so the veracity is immediately suspect, but the incident bears serious investigation. I have no knowledge on any placebo strong enough to allow a patient to ignore surgical pain. Supposing that this is not simply a hoax through and through (it could be), something is at work here, and if it can be controlled and replicated, it will be useful.

I have no inherent like nor gain anything from advocating acupuncture. I'm trained in Western medicine. I don't understand or administer acupuncture. Heck, I'm not even advocating it, just so we're perfectly, perfectly clear.

I'm advocating science. We don't know whether or not any of this works, and we ought to maintain a clearly skeptical outlook on any position on any specific procedure, for or against. The stuff you linked is exactly what I was talking about before. It's understandable that Western physicians should be skeptical of new procedures with unscientific theory behind it, but it is not scientific to dismiss them outright, and it's especially suspicious because it works to their own monetary interests, and the contrary studies often suggest and have negative spins rather than being completely objective.

I waffle. I agree with the sentiment that FDA or AMA oversight/regulation serves more to legitimize pseudo medicine.

This, in fact, our very own OP used language that is already leading to this trap.

krev82 wrote:

My opinion - at least as much as the rest of medicine.

That said, there is obviously room for some regulation, and I am guessing that actually enforcing existing rules would be fine. I know that recently some claims about cereal contributing to lower blood pressure were removed from the box because they were nearing or exceeding the standard of something that would be considered medicine.

The first link is an editorial, not a study, and the "study" it's referencing is a review of reviews - third hand meta-analysis at best.

The second link is a test of a specific technique for a specific complaint. It may or may not be more effective than placebo, but the fact that they failed to account for placebo effect is itself a sign of questionable study design. Suggesting inefficacy due to placebo effect without actually including testing it out suggests a biased perspective, since all reputable controlled studies ought to have placebo controls.

Well, first of all, you got the links wrong. The first is the study, which did take your concerns into account, and the second is the editorial. Funnily enough, the links you provided help to prove the point of the editorial: that over all the thousands of studies that have been done, results are all over the map and none seem to agree with each other, which is a bit strange for something that "is proven to work."

LarryC wrote:

I'm advocating science. We don't know whether or not any of this works, and we ought to maintain a clearly skeptical outlook on any position on any specific procedure, for or against.

I agree with you, but after decades of research showing no real results at some point we need to stop beating the dead horse and focus on treatments that are somewhat less... subjective in their efficacy.

Well, first of all, you got the links wrong. The first is the study, which did take your concerns into account, and the second is the editorial. Funnily enough, the links you provided help to prove the point of the editorial: that over all the thousands of studies that have been done, results are all over the map and none seem to agree with each other, which is a bit strange for something that "is proven to work."

Not particularly. If you think about it, it's a large body of knowledge that was amassed haphazardly and unscientifically. Until recently, this was true of Western medicine as well, and what we hold efficacious in medicine now is so unlike what it was like 150 years ago that it's practically a different discipline. Judged by this perspective, "proving the efficacy" of Western medicine as a single monolithic thing also yields results that are also all over the map and have varying viewpoints, occasionally points that are contrary to each other.

It's just science as usual.

If we had a body of knowledge that introduced us to a heretofore unknown concept of deriving medical agents from plants (theoretically), much of that knowledge could be totally bunk, but a small portion could be useful. It is important to keep perspective and assess facts on an individual basis. The studies aim to measure the efficacy of specific procedures, not to substantiate acupuncture theory on the whole.

I agree with you, but after decades of research showing no real results at some point we need to stop beating the dead horse and focus on treatments that are somewhat less... subjective in their efficacy.

Er, Singapore General Hospital actually has an acupuncture center that has practitioners that are overseen by hospital procedures and all the accountability that implies. There are real results here, and real benefits.

If these people aren't certified by the government they shouldn't be able to treat any disease or illness. That's why we have government regulations, to tell us what we are allowed to take to get well. Otherwise big Pharma would have us taking all sorts of pills that do nothing, while claiming all sorts of things about how good they are for us.

I agree with you, but after decades of research showing no real results at some point we need to stop beating the dead horse and focus on treatments that are somewhat less... subjective in their efficacy.

Er, Singapore General Hospital actually has an acupuncture center that has practitioners that are overseen by hospital procedures and all the accountability that implies. There are real results here, and real benefits.

And I'm sure that the patients being treated are getting all sorts of placebo-y goodness from the soothing talk and physical contact that the acupuncturists are administering while they jab people with needles, that doesn't mean that it's the jabbing that is doing them good. That's why studies exist in the first place.

LarryC wrote:

It's just science as usual.

We aren't going to start that tired discussion with you again, are we? If so then I am wearily backing out.

And I'm sure that the patients being treated are getting all sorts of placebo-y goodness from the soothing talk and physical contact that the acupuncturists are administering while they jab people with needles, that doesn't mean that it's the jabbing that is doing them good. That's why studies exist in the first place.

Right. In general, actual hospitals only allow acupuncturists to do procedures that have shown to have benefits greater than placebo in a study with a reasonable sample size and power. It is unscientific to insinuate that a specific procedure is not efficacious based on the results of testing another procedure for another ailment.

It is precisely the sort of oversight and accountability that's lacking in the American alternative medicine marketplace.

And I'm sure that the patients being treated are getting all sorts of placebo-y goodness from the soothing talk and physical contact that the acupuncturists are administering while they jab people with needles, that doesn't mean that it's the jabbing that is doing them good. That's why studies exist in the first place.

Right. In general, actual hospitals only allow acupuncturists to do procedures that have shown to have benefits greater than placebo in a study with a reasonable sample size and power. It is unscientific to insinuate that a specific procedure is not efficacious based on the results of testing another procedure for another ailment.

Science. Critical thinking. They work.

I phrased that sentence poorly and I think you misunderstood, I was trying to say that in the example you provided of hospital accupuncturists, patients are receiving three types of care:

Both #1 & #2 are being provided by the accupuncturist while s/he administers #3, but are not actually part of what most people consider #3, they are just a side effect of receiving any treatment. Both #1 & #2 have consistently been shown to provide beneficial health effects, while #3 has shown mixed results at best, yet it is #3 which is being credited for the results in this instance.

I am aware of what placebo is, and I am similarly aware of therapeutic communication. Most MDs are, and definitely, the MDs who conduct the reputable acupuncture studies know that their peers are. As I mentioned, hospitals generally only allow treatments that backed by studies that have placebo controls and appropriate study sizes (and a similarly methodology used to apply the placebo, of course).

I understood what you said perfectly, and I'll repeat what I said before. Insinuating that a specific procedure is ineffective because of the results of testing on another procedure is unscientific. Forget science, that just doesn't make sense. Disproving the efficacy of surgery in improving the 5-year outcomes of cervical CA patients has nothing to do with the efficacy of salbutamol in treating an acute asthmatic attack, and it makes no sense to relate one to the other just because they're both Western medical practices.

I must apologize for this. I mean nothing untoward, but I believe that your manner of thinking here is ironically the reason for why these snake oil salesmen continue to make a living. It is profoundly and fundamentally uncritical. I can't help but think (based on long experience) that most Americans think according to the process you've employed here.

I mentioned, hospitals generally only allow treatments that backed by studies that have placebo controls and appropriate study sizes (and a similarly methodology used to apply the placebo, of course).

Strange that yours allows accupuncture then. Do they also proscribe homeopathics and tune the patient's vibrational matrices with crystals?

LarryC wrote:

I must apologize for this. I mean nothing untoward, but I believe that your manner of thinking here is ironically the reason for why these snake oil salesmen continue to make a living. It is profoundly and fundamentally uncritical.

No. No reputable studies have ever shown any procedures along those disciplines to be better than placebo. I still maintain a skeptical outlook. If anyone can show me evidence that such a procedure is better than placebo (or proves the contrary), I'll be willing to review it.

*I'm* the one being uncritical? Really?

I'm quite serious.

There seems to be this mistaken notion that "critical thinking" means adhering to mainstream thinking, and having a secular, atheistic outlook, at least on these forums. This is a mistake. Critical thinking is this:

The list of core critical thinking skills includes observation, interpretation, analysis, inference, evaluation, explanation, and meta-cognition. There is a reasonable level of consensus among experts that an individual or group engaged in strong critical thinking gives due consideration to:
Evidence through observation
Context
Relevant criteria for making the judgment well
Applicable methods or techniques for forming the judgment
Applicable theoretical constructs for understanding the problem and the question at hand
In addition to possessing strong critical-thinking skills, one must be disposed to engage problems and decisions using those skills. Critical thinking employs not only logic but broad intellectual criteria such as clarity, credibility, accuracy, precision, relevance, depth, breadth, significance, and fairness.

It is, at its core, the willingness to question anything, and everything, all the time. If the issue is "Is the Sun revolving around the Earth?" critical thinking is the ability to question both "Yes" and "No" answers equally, and to withhold judgement indefinitely, holding both positions eternally in question, except where it is necessary to decide on a provisional answer.

It is uncritical to even ask the question "Does acupuncture work?" in the context of a procedural question, since that is not the question that is being asked. The question is "Does this procedure work?" and it is important to note that the answer arrived at in a study of that procedure is only most relevant to the immediate question.

A paper entitled "Does acupuncture procedure Z work in alleviating hand cramps?" only works to answer that question only, it neither substantiates nor repudiates the underlying meridian theory, or the efficacy of acupuncture in general.

I still maintain a skeptical outlook. If anyone can show me evidence that such a procedure is better than placebo (or proves the contrary), I'll be willing to review it.

After the discussion we just had, this is the most unintentially hilarious thing I've heard all week. Thank you, Larry!

EDIT: we are cross-posting like crazy. Anyway-

Critical thinking is the technique by which we make judgements, it is not a solipsistic ouroboros of questions swallowing themselves.

dictionary wrote:

Main Entry: critical thinking
Part of Speech: n
Definition: the mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion

It even says so in that thing you quoted:

whatever it was that LarryC quoted wrote:

The list of core critical thinking skills includes observation, interpretation, analysis, inference, evaluation, explanation, and meta-cognition. There is a reasonable level of consensus among experts that an individual or group engaged in strong critical thinking gives due consideration to:
Evidence through observation
ContextRelevant criteria for making the judgment well
Applicable methods or techniques for forming the judgmentApplicable theoretical constructs for understanding the problem and the question at hand
In addition to possessing strong critical-thinking skills, one must be disposed to engage problems and decisions using those skills. Critical thinking employs not only logic but broad intellectual criteria such as clarity, credibility, accuracy, precision, relevance, depth, breadth, significance, and fairness.

Compare this "use these skills to make judgements" with this:

LarryC wrote:

It is, at its core, the willingness to question anything, and everything, all the time. If the issue is "Is the Sun revolving around the Earth?" critical thinking is the ability to question both "Yes" and "No" answers equally, and to withhold judgement indefinitely, holding both positions eternally in question, except where it is necessary to decide on a provisional answer.

Ah yes, good catch and not the intended implication. I'll leave it in admission of semantic error.
---

I do not think there is anything wrong with an adherent of these treatments applying for and going through the process of scientific testing to demonstrate efficacy. Anecdotally though I've observed that they tend to be fairly unfalsifiable stances and when shown to have no effect or even negative effect the adherents will conjure every excuse imaginable. At some point it's no better than attempting to dissuade a conspiracy theorist, 'skeptic' is a dirty word and you're clearly just a hit man against 'open mindedness' hired by big government/big pharma.

Maybe some of this stuff really is of medicinal or even just psychological value but the toxicity of the charlatans in these sectors makes the whole business extremely murky while also resulting in or even directly causing needless suffering.

To the moon wrote:

The ending isn't any more important than any of the moments leading to it.

I see no disconnect whatsoever. Having to answer the question in the past has no relevance to the answer we ought to give in the present except as reference. Just because we answered "Yes," before doesn't mean we should now just because we already had to answer that way once or even several times before. Just as well, answering a particular way now has no immediate relevance to future answers.

Hence, all positions are held forever in question.

The relevance of past answers is in short cut and review. The relevant question is "Have we had any new evidence, view, or context now that we did not have before in answering this question?" It is important to remember to ask the right question. All too often, the question becomes "How did we answer before?" This last question is largely irrelevant except in the context of the real question, and more importantly, it skips every mentioned factor thought to be relevant in practicing critical thinking.

The sites you linked, and you yourself are asking the wrong questions, which is why I question your ability to think critically, which, if Robear is to be believed, a fairly common failing. This explains why the snake oil snakemen earn a living; which, as I said, is ironic given your stated position on the alternative medicine question.

Specifically, the question is "Does this treatment work?"

Unscrupulous acupuncturists will avoid answering that question and instead try to substantiate why acupuncture works, hoping that your mind will mentally bridge the gap through sloppy thinking, which most people apparently do.

Unscrupulous doctors will also try to avoid answering that question and try to substantiate why acupuncture doesn't work, and hoping that your mind will bridge a similar gap.

Do you see? They are using the exact same methodology obfuscating the exact same question, only in different directions.

A scientist will answer only the relevant question, and with specific studies, pointing out both strengths and weaknesses. More importantly, he will NOT answer the question "Does acupuncture work?" since that is not the question that is being asked.

Equally, as a patient, you should also not ask "Does Western medicine work?" You should be asking "Is what you're proposing to do for me going to have the benefits you claim it has?"

The basic problem isn't lack of oversight, but lack of critical thinking in the general populace. Oversight is only a failsafe, and itself requires leaders to think critically.

I see no disconnect whatsoever. Having to answer the question in the past has no relevance to the answer we ought to give in the present except as reference. Just because we answered "Yes," before doesn't mean we should now just because we already had to answer that way once or even several times before. Just as well, answering a particular way now has no immediate relevance to future answers.

Hence, all positions are held forever in question.

Okay, I guess we should put forth some serious studies determining the efficacy of phrenology and placating the five humours. Otherwise, dagnabbit, how will we know if we are missing out on some important medical knowledge!

Scientific study is human, and in a capitalistic society, is profit driven. If you can convince a local MD that researching in that direction has a probability of yielding usable results, he'll probably take you up on that.

Let's be real, here. The reason SGH is sponsoring medical research on acupuncture is because there is real, honest to goodness interest in their population in it, and thus, money. Patients will pay for acupuncture treatments backed by reputable peer-reviewed research when they won't for unsubstantiated practices.

Of course you're still asking the wrong question! We do not study the efficacy of phrenology. We study the efficacy of a specific procedure.

Similarly, we do not study the efficacy of pharmacology! We study the efficacy of rofecoxib in reducing the pain scores of patients in acute gouty attack.

My apologies. As I've stated explicitly, your modes of thinking and reply exemplified in this thread are a case-in-point for why these tragedies happen, assuming that you can be considered representative of a significant fraction of the average American population. I do not think it is profitable (or fair) to draw out more examples from you on this score - the back and forth reply record show this adequately already at this point.